Prevalence of S3 and S4 in emergency department patients with decompensated heart failure

Abstract

Study objectives: The presence of abnormal diastolic heart sounds (S3 and S4) is indicative of elevated ventricular filling pressures and suggests decompensated heart failure. We sought to determine the prevalence of abnormal diastolic heart sounds in emergency department (ED) patients presenting with signs or symptoms of decompensated heart failure. We hypothesize that an S3 and S4 will be observed more often in heart failure patients than in patients without heart failure. Methods: The study was a prospective, convenience sample of ED patients who had signs or symptoms of decompensated heart failure. Baseline demographic, clinical, and laboratory data were collected. The presence of an S3/S4 was determined using the Audicor system, a validated device that algorithmically detects S3 and S4 heart sounds. A diagnosis of decompensated heart failure was based on attending physician discharge summary. The prevalence of an S3 or S4 was determined in patients with a primary diagnosis of decompensated heart failure, a secondary diagnosis of heart failure, and a non–heart failure diagnosis. Data are described with 95% confidence intervals (CIs) for proportions. Results: There were 135 patients enrolled; 49.6% were men and 56.3% were black. The prevalence of an S3 was more than threefold higher in decompensated heart failure patients (41.3%) than in non–heart failure patients (13.2%). The prevalence of an S4, although much smaller in magnitude, was also higher in decompensated heart failure patients (17.4%) than in non–heart failure patients (5.9%). Although the differences were not as marked, those patients with a secondary diagnosis of heart failure also had an increased prevalence of S3/S4 compared with the group with a non–heart failure diagnosis. Table, abstract 318Prevalence of S3 and S4 in all patients. All, No. (%) (N=135) Primary HF, No. (%) (N=46) Secondary HF, No. (%) (N=21) No HF, No. (%) (N=68) Heart sounds: S3 (prevalence) 34 (25.2) 19 (41.3) 6 (28.6) 9 (13.2) 95% CI 18.6–33.1 28.3–55.7 13.8–50.0 7.1–23.3 Heart sounds: S4 (prevalence) 16 (11.9) 8 (17.4) 4 (19.0) 4 (5.9) 95% CI 7.4–18.4 9.1–30.7 7.7–40.0 2.3–14.2 Primary HF, Primary diagnosis of decompensated heart failure; Secondary HF, secondary diagnosis of decompensated heart failure; No HF, non–heart failure diagnosis. Open table in a new tab Study objectives: The presence of abnormal diastolic heart sounds (S3 and S4) is indicative of elevated ventricular filling pressures and suggests decompensated heart failure. We sought to determine the prevalence of abnormal diastolic heart sounds in emergency department (ED) patients presenting with signs or symptoms of decompensated heart failure. We hypothesize that an S3 and S4 will be observed more often in heart failure patients than in patients without heart failure. Methods: The study was a prospective, convenience sample of ED patients who had signs or symptoms of decompensated heart failure. Baseline demographic, clinical, and laboratory data were collected. The presence of an S3/S4 was determined using the Audicor system, a validated device that algorithmically detects S3 and S4 heart sounds. A diagnosis of decompensated heart failure was based on attending physician discharge summary. The prevalence of an S3 or S4 was determined in patients with a primary diagnosis of decompensated heart failure, a secondary diagnosis of heart failure, and a non–heart failure diagnosis. Data are described with 95% confidence intervals (CIs) for proportions. Results: There were 135 patients enrolled; 49.6% were men and 56.3% were black. The prevalence of an S3 was more than threefold higher in decompensated heart failure patients (41.3%) than in non–heart failure patients (13.2%). The prevalence of an S4, although much smaller in magnitude, was also higher in decompensated heart failure patients (17.4%) than in non–heart failure patients (5.9%). Although the differences were not as marked, those patients with a secondary diagnosis of heart failure also had an increased prevalence of S3/S4 compared with the group with a non–heart failure diagnosis. Primary HF, Primary diagnosis of decompensated heart failure; Secondary HF, secondary diagnosis of decompensated heart failure; No HF, non–heart failure diagnosis.